[# Gomez: Little Pieces]
[Alex] Surgeons are all messed up. We're butchers.
Messed up, knife-happy butchers.
Sir? Would you like a cot set up for you in her room?
[Alex] We cut people up. We move on.
Patients die on our watch. We move on.
No. I'm a doctor here.
[Alex] We cause trauma. We suffer trauma.
Wait.
And here it comes.
[music gets louder, faster]
[Alex] We don't have time to worry about how blood and death makes us feel.
This is how you unwind?
By watching two hours straight of advanced carotid endarterectomy?
Cristina?
- [music fades out] - [fan whirring]
[gasping]
- [items clattering] - [gasping]
- [Callie] Everything OK? - [knocking at door]
- [door opening] - [Callie] Cristina? Owen!
[gasping]
[gasping, coughing]
[panting] What...? What?
[sobbing]
[phone ringing]
It's three in the morning, Cristina. This better be...
Callie?
What?
He what?
- [knocking at door] - [Meredith] It's me. Cristina!
[unlocks door]
What's going on? Owen's out there upset,
- Callie was screaming... - No changes in visual acuity.
No petechiae. I'm fine.
Oh, my God! Your neck! I will kill him!
No, no, no. He had a nightmare.
- [knocking at door] - [Owen] Cristina, please.
Is she all right? I just need to know that she's all right.
No, no, no. Cristina, no.
I am so sorry.
I don't know what happened. I don't know what happened.
- I'm sorry. - Look at me.
I'm fine. See? It's OK. You were asleep.
It's OK. OK? It's OK. It's OK.
- I'm sorry. - It's OK. I know.
[Cristina] It's OK. You were asleep. It's OK. OK? It's OK.
It's OK. It's OK. It's OK. It's OK.
There's coffee.
[Meredith sighs]
No. Not like this.
Today's your first day back at the hospital. Today's about Izzie.
You have to operate on her brain. You have a gift.
And you can do this.
I'm gonna shower before I go in.
You're wearing a turtleneck under your scrubs.
It's ugly.
Not as ugly as the fact that you hugged him.
- You hugged him... - I get it. I hear you. Move on.
Turtlenecks aren't OK. You're not OK. Your boyfriend is not OK.
- Is your boyfriend OK? - [both] What?
To be cutting into brains today. Is he OK to be back?
Yes. Of course. Derek is fine.
I was there for his carnage in the OR, remember? This isn't just any patient.
This is Izzie.
[Callie] George, hey. I'm surprised you're not...
Isn't there a presentation happening with Izzie?
I didn't know she was sick. Bailey told me after Cristina told her.
Izzie trusted Cristina. I was the very last to know.
- I'm sure Izzie wasn't trying... - I don't want to talk about it.
I want to work. Do you have any room on your service?
- Yeah. Three hip replacements... - Thank you.
You three. I understand why you're here. You want to help.
I will be the resident on her case. I will be prepping her for surgery.
If you're going into that hospital room, you will do so as her friends.
Izzie needs her people around her to tell her everything will be fine.
She needs you to hold her hand. She needs you, not more doctors. Understood?
Great. Let's get started.
As you know, you have stage-four metastatic melanoma.
We have surgeries and procedures lined up for you over the next few weeks.
We've seen mets on your liver, so one of those surgeries,
Dr. Bailey and I will resect them. We also lined up Dr. Parker from OB
to harvest as many healthy eggs as she can before you undergo any radiation.
- Right. Babies. - Leaving the option open,
- if you want it. - [Derek] But our priority
is to address mets in your brain. I'm surprised we didn't catch it.
It causes headaches, seizures, hallucinations.
Hopefully the lesion has clear margins and I can remove it.
Are you people done?
Over the next four weeks, you're slated for three major surgeries,
seven outpatient procedures, just for mets we've found.
In all likelihood, we will find more. We may have to cut into you more.
You may as well get used to the idea now.
I'll be administering your radiation, chemotherapy and immunotherapy.
The treatment will be aggressive, it will be harsh. Prepare yourself.
I'll be overseeing procedures, including today's,
which means every surgeon in this room now answers to me.
Welcome to the cancer wing, folks.
See you in the OR.
Thanks.
Seriously, don't just stand there staring at me. It's making me nervous.
- Get out of here. Go save lives. - Yeah, we have rounds.
- Yeah. - OK. See you later.
[woman on PA]
Karev, I just reviewed Izzie's most recent MRl.
Doesn't look like the tumor has grown since her last scans.
Do you have concerns you'd like to discuss with me before we brief Izzie?
Just try keeping her frontal lobe inside her skull this time.
[Derek] Good morning, Izzie.
- You coming? - No. I'm on this old lady, so...
- This'll only take a minute. - I gotta go, really.
Hi, Dr. Sloan. These are Aunt Joyce's nephews, my brothers Tobin and Luke.
They flew in early this morning. Dr. Sloan did the surgery.
I'm sorry. Your aunt is very sick. There's not much more we can do for her.
- Probably time to say your goodbyes. - Do you mean say our goodbyes now
or sometime in the next 24 hours?
I mean, what kind of time frame are we talking about?
- Twenty-four hours seems unlikely. - You sure?
Because I have a flight to catch in the morning,
and if I wait past noon, I can't change it.
I need to be on a plane tonight. Board meeting tomorrow.
So do you think she'll die before tomorrow?
You really think Shepherd's the guy for Steven's surgery today?
- Someone else in mind? - Shepherd wouldn't be my choice,
given his recent history, but it's not my brain he'll be manhandling.
- No. - Damn. She's HLA type B3.
Have to hit her with the DTIC and high dose IL-2 instead.
- IL-2? That's pretty toxic. - It's about as bad as it gets.
- You're gonna tell Izzie this now? - I am her oncologist.
Studies show giving patients bad news before surgery
can drastically increase their chances of complications.
Today or tomorrow, the news is the same. Right now, I have time.
You coming?
I believe Izzie is down in radiology now.
Fine. We can wait an hour.
- Chief, you paged me? - Karev. Yes, I did.
Um...
As you know, we're gonna be harvesting eggs.
From Stevens.
Who, I believe, is someone you're having relations with.
- Chief. - Frozen eggs have a better
survival rate when they're... fertilized.
- Fertilized. - I know this is a lot to digest.
So take some time, think about it.
If you decide this is something you might consider...
- Give me the cup. - Karev. Speak to Stevens.
Just give me the cup!
- Is she doing OK? - Yeah. Well, she says she is.
- Do you believe her? - No. Not really.
Oh. Heads up.
- What do you hear? - Motorcycle lost control. No helmet,
massive head trauma, lost vital signs en route.
- Good to have you back, Shepherd. - Thanks.
[blades whirring]
Get back inside. He's DOA.
Hunt? Did you hear me?
Owen.
[beeper beeping]
Swender has no vision.
He wrapped his hands around your throat, you're pretending nothing happened.
Focus on Izzie.
Hunt literally tried to kill you. He's barely back from Iraq.
It's obvious he has issues. That doesn't mean you have to stand by...
If he had a heart attack or a stroke or lost a leg, would you walk away?
How is it acceptable I walk away from this? He's wounded.
He has war wounds, Meredith.
It's not cut and dried. And it's not as bad as you think it is.
- [machine beeping rapidly] - [Alex] Clear.
- This might be it. - From your lips to God's ears.
- Charge to 360. Clear. - [paddles zap]
- [machine beeping slowly] - [gasps, coughs]
- Oh, for the love of God. - Hey.
You know how many people are in this hospital waiting,
hoping loved one might live? You're a bunch of vultures.
- But we're not. - Aunt Joyce was given a month to live
three years ago. And we were crushed.
And we held her hand at her bedside for weeks,
and we said our tearful goodbyes. And then...
...she stabilized.
She's been in and out of the hospital once a month.
Each time we jump on a plane, sit by her bed, say our goodbyes all over again.
And each time, she winds up getting better.
We want to be here when she goes. We really do.
But... it's a lot of flying around the country.
She's ready. We're all ready. It's time.
And I've got a board meeting tomorrow.
Big one.
They're doing tests that show altered brain anatomy in patients with PTSD.
Close to understanding the physical side of psychological trauma.
- Amazing what you can see with an MRl. - What did Meredith tell you?
Post-traumatic stress is a real injury, Owen.
It can be healed. There are resources, vet centers, therapy.
You shouldn't try and handle this on your own.
I came back in one piece, both arms, both legs.
Lots of guys came back with real injuries.
The worst I have is nightmares or freezing for a moment...
Is that what happened last night? You had a freezing moment?
If you want, I can help.
Oh, yeah?
I'm not the one who needs help. I'm not the one who cut out half a brain
and ran off to hide. I'm not the one half the hospital is talking about.
You should spend less time worrying about me and take a look in the mirror.
Karev? Just checking in. To see how you're com...
- See how you're doing. - I'd be doing better
if you weren't on the other side of the door listening.
Uh... Right, right. Sorry.
- [knock on door] - I said go away.
You left the door unlocked. That's bold.
- The chief send you in here? - No. I offered to come in
- in case you need to talk. - You think talking will help?
A Dixie cup full of my swimmers will make everything OK? It's crap.
This is crap!
You can't go messing with people's heads like that.
Even if she freezes the embryos, you think we'll get a chance to use them?
You think she'll still be here?
You think she'll survive all this? You think...
I think... She told me... She told me she was seeing a ghost, OK?
And I'm so used to all the crazy chicks in my life that I didn't even...
I'm a doctor. A doctor!
And I didn't even think to...
And now she's... This is...
This is wrong. This isn't how it's supposed to happen.
- I know. - It's crap!
- I know. - I hate this.
- I know. - [# Sanders Bohlke: The Weight Of Us]
This isn't...
This isn't how we were... This isn't how I wanted to do this.
This isn't how Izzie and I were supposed to make a baby.
I haven't seen you all day.
What if I hadn't woken up?
I can't even remember what happened. I have no memory, no way to...
I would never hurt you, ever.
But I did. My hands just...
How could my own two hands be capable...?
- I can't do this, Cristina. - But you did wake up.
- Stop blaming yourself. - We have to stop seeing each other.
Why?
- Cristina, I almost... - Almost what?
I told you, I know my limits.
Let me decide what I can handle.
Good. Stand right there. Let me see.
- I never know how long to make these. - I like the color. Who's it for, Karev?
- Haven't seen much of him today. - He's working. They're all working.
I told them to go work. Their patients shouldn't suffer
because I have things growing on my organs.
I have got a colectomy this afternoon. If you were the resident assisting me,
and I were to say to you, "Divide the cecum," what would you use?
I'm not assisting you. You're not gonna ask me to divide the cecum.
But you're not going to get rusty. In a year, you need to do this stuff.
You need to teach residents.
- Think I'm gonna be here in a year? - Yes, I do.
So I have exposed the right lower quadrant,
and you are dividing the cecum with...
Forceps.
Lift free from the arachnoid.
Tacking sutures.
Patties.
Suction.
[sighs]
[exhales]
[inhales deeply]
Starting over.
[Alex] Here's your cup, all filled up.
- I'm eating here, Karev. - It's fine, I washed my hands.
Did you talk to Izzie about this yet? Considering you two are basically
conceiving a child together, think you should talk with her?
Look, you said she needed my... contribution.
Here's my contribution. Whatever.
- Hi. How's Izzie? - I don't know.
- How's Izzie? - Why?
- Have you been to see her? - No, I've been working all day.
- What? - Have you been to see Izzie?
No. Haven't you?
[door opens]
- You finished that thing in one day? - Had some free time.
- Had a lot of free time. - Nobody came up to visit?
It's OK. If I were them, I wouldn't want to step foot in this room either.
- You don't have to keep checking on me. - I do have to.
I have to start you on this before your surgery.
Right. Surgery.
And I wanted to tell you how my surgery went this afternoon.
- Colon guy? - The colectomy went great,
but I was in there, and I see a mass.
- You're kidding. Was it a big mass? - Big enough. The size of a fist.
This is going to burn a little at first, but just for a few seconds.
So we had to mobilize the SMA
before we could resect the thing and reconnect the bowel.
I wished Izzie Stevens would die.
I wished her dead. Every day, for I don't know how long.
I woke up every morning wishing Izzie Stevens would die. And now...
What kind of person wishes someone would die?
What kind of doctor wishes...? Knowing how things happen, what...?
What kind of...? What kind of doctor wishes...?
Are you in here, right now, praying for Izzie to die?
No. I'm praying for her to live.
[machine beeping rapidly]
- Clear! - You know what?
- Wait outside! - Will you let us know...?
Yeah. I'll let you know.
- Bastards. - Push one of epi.
Charge to 360. Clear!
Come on, Joyce, you old bag, don't give 'em the satisfaction.
- Charge again. - [woman] Charged.
Clear!
[machine beeping slowly]
Hey. I'm Dr. Karev.
You're a fighter, you know that? You worked hard today.
She needs some rest.
Make sure the family doesn't come in. Give her a break from all the love.
No. They're impatient.
It's been a long time.
But they always come.
They're my people.
People keep you going.
People are better than no people.
Uh... It's not a good time, he's still scrubbing in.
I know, it's just... he should wear this.
It's his ferryboat scrub cap. He loves ferryboats.
- Meredith. - What are you doing?
You're gonna have to re-scrub.
- I'm not ready. - Yes, you are.
I need to know that at least I have you.
No matter what happens in there, I need you to say yes.
- I need to know... - I can't say yes.
Not if agreeing to be with you forever will make it OK if Izzie dies.
I can't say yes. I love you, and you can do this.
You can do this. I know you can.
[# Cinematic Orchestra: That Home]
Iz!
See you soon, Dr. Stevens.
- Hope so. - Know so.
- Dr. Bailey, if something goes wrong... - It won't.
The scarf.
I made it for you.
Beautiful night to save lives.
Let's get started.
I get why I haven't been camped out at Izzie's bedside holding her hand...
- I'm not talking about this. - Why not?
Maybe it's the fact that I asked Izzie a hundred times what was wrong,
and she just ignored me.
Then there's the fact that when she actually needed help,
she trusted Cristina, of all people!
And there's the fact that she's your best friend, and she might die on you.
There's also that.
Come on. We are going to go wait for Izzie.
George, you were my husband and you slept with her.
You are the reason I wished her dead. You owe me this.
You can lie to yourself all you want, but I know you. I loved you once.
And I know you care if she lives or dies.
Surgery started.
- Hey, have they started surgery yet? - Yeah.
Dr. Grey? We were wondering, did Dr. Stevens' surgery start or...?
Keep it moving. No loitering. That's the rule.
If they wanna stay, let 'em stay.
People are better than no people.
[Derek] Clamp.
I am ready to... No.
Yes. OK. I'm ready to buzz the superficial temporal artery.
- Tenting sutures. - There's no rush. Take your time.
- Everyone is on your side. - You sure that's gonna hold,
- with all the friable scar tissue? - Dr. Swender?
Actually, I saw Dr. Shepherd do three different craniotomies last month,
each with easily double the amount of friable tissue.
They held just fine.
Next tenting suture, please.
[Lexie] Clear!
Push another epi. Charge again. Come on, Mrs. Wallington. Clear!
[machine flatlining]
I'm so sorry. She's not responding. We've done everything, so she's gone.
Thank you. You did a wonderful job.
[machine beeping slowly]
- Are you kidding me?! - Oh, God, this is never gonna end!
No... No, she's gone. She's really gone.
It's really gone. It's her pacemaker.
It's still firing. Makes it seem like there's a heartbeat. She's gone.
Just with a heartbeat.
- Are you sure she's dead, young lady? - I'm an intern.
I'm not authorized to call time of death in a situation like this.
So I'm gonna get my superior.
Excuse me. I'll be right back. Excuse me.
- [Meredith] I'm worried about you. - [Cristina] Meredith...
- Choking. - Stop.
- It's unacceptable. - Back off.
- Hands around the neck. - Ring thrown in your face.
[machine beeping slowly]
This'll shut the pacemaker down.
- [machine flatlining] - [Mark] Time of death, 2240.
There you go. She's officially dead. You can catch your plane.
Get to your board meeting. You can leave.
[# Ben Lee: Rise Up]
Actually, could we stay a little while longer?
[Richard] What are you all doing out here?
Waiting for Izzie, sir. We're waiting.
You're scared.
I'm scared too.
Damn it. Some of the Sylvian vessels are wrapped around the tumor capsule.
- Penfield four, please. - Really?
- Instead of the arachnoid knife? - Yes, instead of the arachnoid knife.
Because the Penfield four will let me slide the arteries around the met.
I need to dissect it free so I can de-bulk the tumor,
avoiding unnecessary trauma to my patient. So, yes, Penfield four, please.
- Vitals stable the entire time? - Spikes or intracranial pressure?
- Was there residual tumor? - Shepherd resected all of the tumor.
She'll be in the PACU for an hour. She's fine.
Your friend is just fine. No thanks to any of you.
Tomorrow, do better.
- The surgery went well today. - Mmm.
Shouldn't you and Meredith be out celebrating or something?
She turned me down twice.
She said she understands, she forgives me for what happened in the woods.
So you showed her your dark side.
Meredith never struck me as a woman who's afraid of the dark.
I don't know.
Do you know it was Meredith's idea to ask Izzie
if she wanted to harvest her eggs?
So Izzie could have a chance at the future she wanted. The future, Derek.
She was confident you'd succeed today.
Meredith believes in you.
[# Peter Broderick: With the Notes In My Ears]
[turns on electric shaver]
I'm here, Iz.
I'm right here.
- Izzie's surgery went well. - Good. That's good.
I wish things were...
That they could be...
- That we could be... - Me too.
Could I hold you?
[elevator bell dings]
- Wait! No. You can't take that one. - Why not?
I said don't take it.
I will take the elevator I want to take.
[elevator bell dings]
Well, go on.
[# O+S: We Do What We Want To]
Hey. Come on in.
This is a CT for Katie Bryce.
16-year-old female, subarachnoid aneurysm.
From a fall during gymnastics. I remember.
It was the first surgery we ever scrubbed in together on. Our first save.
Right here is a cerebral cyst. Tough save, but we did it.
I kissed you in the stairwell after this surgery.
This is where Dr. Bailey kicked you out of the surgery
because she caught us in your driveway in my car.
[laughing]
And right here, this was a seven-hour craniotomy.
You held a clamp the entire time and never flinched.
That's when I knew you were gonna be an incredible surgeon.
Beth Monroe, who made our clinical trial a success by surviving.
You talked me into putting her under.
That's when I knew I needed you.
And this is today. Post-op head CT of Izzie Stevens.
See that?
Right there. Tumor-free.
Because of you. You got me into the OR.
If there is a crisis, you don't freeze.
You move forward.
You get the rest of us to move forward because you've seen worse,
you've survived worse. And you know we'll survive too.
You say you're all dark and twisty.
That's not a flaw.
It's a strength.
It makes you who you are.
I am not gonna get down on one knee.
I am not gonna ask a question.
I love you, Meredith Grey.
And I want to spend the rest of my life... with you.
And I want to spend the rest of my life with you.
I don't think...
I can't handle this after all.
What...? What do you mean?
- Are you saying...? - I'm sorry.
I am so, so sorry.
But I'm lying here in your arms...
...and I'm afraid to fall asleep.
[Alex] Doesn't matter how tough we are.
I want to apologize for earlier.
- What I said was... It was out of line. - It's already forgotten.
Thank you for doing this.
[Alex] Trauma always leaves a scar.
I'm engaged.
I broke up with Owen.
[Alex] It follows us home.
It changes our lives.
Hey.
I snooched into a cup for you today.
Thank you?
[Alex] Trauma messes everybody up, but maybe that's the point.
All the pain and the fear and the crap...
Maybe going through all of that is what keeps us moving forward.
It's what pushes us.
Maybe we have to get a little messed up
before we can step up.